The effect of distance to a health facility on childhood mortality in rural Burkina Faso, West Africa

Objective: Adequate access to health care services is an essential factor for the reduction of child mortality in Sub-Saharan Africa. The aim of this study is to determine the effect of distance, measured as mean walking duration to the closest health facility, on infant and child mortality, with respect to a set of further conditional factors from a previous publication. Methods: Longitudinal population data for the inhabitants of 42 villages in Nouna district (n≈67.000) were available from the database of the Nouna Health and Demographic Surveillance System (HDSS) in rural Burkina Faso. 24555 children born between 1993 and 2005 within the HDSS were investigated in this study. Walking time from each village to the closest health facility was obtained for dry and rainy season and its impact on infant (<1 year) and child (1–4 years) mortality was studied using Cox and Poisson regression analysis. Findings: We observed 1566 and 1860 infant and childhood deaths, resulting in mortality rates of 66 and 23 deaths per 1000 person-years, respectively. Rates decreased significantly during the observation time. The estimated walking times ranged from 5 minutes to 8 hours. Using Cox regression, walking distance was shown to be a highly significant risk factor for infant mortality. A walking time over 4 hours increased the risk for infant mortality by about 60%. Children living in a village without a health facility have a 50% increased mortality, independent of the location of the village. Further influencing factors were sex, religion, ethnicity, death of mother, being a twin, birth spacing and age of mother. Poisson regression analysis yielded similar results. Conclusion: The findings of this study emphasize the importance of fast accessibility of health care for Sub-Saharan populations and demonstrate the need to improve health care in developing countries to achieve the Millennium Development Goals.